September 2004

The head of the National Committee for Quality Assurance says health plans want to encourage physicians in the never-ending quest for quality.
People flock to these services whether insurers cover them or not. When does it make economic and medical sense to offer them?
Physicians are not the only problem. Health plans too often view guidelines as rigid routines rather than flexible aids to good practice.
Although interactive educational seminars that target physicians require a large investment of resources, they can be cost-effective if medical care is improved as a result.
Presenteeism — the condition of being on the job, but giving less than 100 percent — is fertile ground for health plans with a suitable product.

MargaretAnn Cross


The pharmaceutical giant contends that soon-to-be-released data will verify its program’s effectiveness.
An important federal law encourages development of drugs for populations so small that the market would otherwise ignore them. Should they not then be covered?